Utilization Management Nurse

4 weeks ago


Akron, United States Akron Children's Hospital Full time

Full-Time

40 hours/week

Remote

Summary:

The Utilization Management Nurse is responsible for conducting medical necessity review to assure appropriate use of hospital resources, and serving as a resource to the hospital staff on utilization management practices.

Responsibilities:

  1. Provides clinical review to health plans as required by the health plan and/or the Utilization Review plan and ensures all days are approved and authorized. Notifies physician advisor when patients do not meet admission or continued stay criteria.
  2. Validates patient registration status with physician order against medical necessity screening criteria and applies evidence based medical necessity screening criteria as defined by the Utilization Review plan. Proactively confers with attending physician to provide coaching on accurate level of care determination at point-of-hospital entry. Ensures that all extended recovery and observation patients are screened at least daily for appropriate level of care.
  3. Assists with denial management, peer review, and quality/safety work to identify opportunities to improve department/hospital processes. Identifies compliance and ethical issues and reports appropriately.
  4. Actively participates in daily huddles, multidisciplinary rounds, and patient care conferences as needed to maintain knowledge about intensity of service, delays in service, barriers to discharge, and progression of care. Identifies and records episodes of avoidable days.
  5. Clearly documents outcomes of all actions taken in Midas and Epic as appropriate.
  6. Serves as a resource to the health care team on issues related to admission qualifications, resource utilization, and documentation improvement opportunities.
  7. Other duties as required.

Other information:

Technical Expertise
1. Experience in inpatient clinical is required.
2. Experience in pediatrics is preferred.
3. Experience working with all levels within an organization is required.
4. Experience in healthcare is required.
5. Proficiency in MS Office [Outlook, Excel, Word] or similar software is required.

Education and Experience
1. Education: Bachelors in Nursing [BSN] is required. For employees hired after July 1, 2013, BSN is required or must be obtained within 5 years from date of hire.
2. Certification: Registered Nurse licensure is required.
3. Years of relevant experience: 3 to 5 years is preferred.
4. Years of experience supervising: None.

Full Time

FTE: 1.000000

Status: Remote

RequiredPreferredJob Industries
  • Other

  • RN Coordinator

    5 days ago


    Akron, United States Summa Health System Full time

    RN Coordinator - Utilization Management & Discharge Planning SummaCare - 1200 E Market Ave, Akron, OH Part-Time / 20 Hours / Days (2 days one wk / 3 days next wk) Remote SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare...

  • Utilities Supervisor

    1 month ago


    Akron, United States Channel Personnel Services Full time

    Job DescriptionJob DescriptionFacilities/Utilities Supervisor is responsible for keeping plant utilities running (boilers, air compressors, fire control systems, etc.), maintaining reliable systems, supporting Preventive Maintenance, and developing the capabilities of the Facilities Technician team. The Facilities Lead will also manage compliance with...


  • Akron, United States Channel Personnel Services Full time

    Job DescriptionJob DescriptionFacilities/Utilities Supervisor is responsible for keeping plant utilities running (boilers, air compressors, fire control systems, etc.), maintaining reliable systems, supporting Preventive Maintenance, and developing the capabilities of the Facilities Technician team. The Facilities Lead will also manage compliance with...

  • Dish Utility

    4 days ago


    Akron, United States Akron, Ohio, United States Full time

    Job Description OLE DESCRIPTION The Dish/Utility at BigShots Golf is responsible to execute game-changing culinary prep of BigShots Golf by living and role modeling the Manifesto and Core Values. The Dish/Utility will provide an outstanding culinary experience for our Guest and Team Member by creating unexpected memories. ...

  • Dish Utility

    5 days ago


    Akron, United States Clubcorp Usa Incorporated Full time

    Job Description OLE DESCRIPTION The Dish/Utility at BigShots Golf is responsible to execute game-changing culinary prep of BigShots Golf by living and role modeling the Manifesto and Core Values. The Dish/Utility will provide an outstanding culinary experience for our Guest and Team Member by creating unexpected memories. The Dish/Utility will be responsible...


  • Akron, United States USIC Full time

    Job Description: As leaders in the utility industry, concentrating on quality and safety, RECONN is looking for people to join our team who are problem solvers, take pride in public safety, and are comfortable in a fast-paced, exciting work environment. Utility Monitoring Technicians are responsible for ensuring the correct, safe, and efficient locates of...


  • Akron, United States RECONN Full time

    Job DescriptionJob DescriptionJob Description:As leaders in the utility industry, concentrating on quality and safety, RECONN is looking for people to join our team who are problem solvers, take pride in public safety, and are comfortable in a fast-paced, exciting work environment. Utility Monitoring Technicians are responsible for ensuring the correct,...

  • Nursing Manager

    2 weeks ago


    Akron, United States Insight Global Full time

    Insight Global is looking for an experienced Nurse Manager to join a growing healthcare support agency sitting in the Akron, OH area. In this permanent position, the Nurse Manager will oversee a team of internal and external nurses, manage day-to-day operations, build the nursing team, and administer in-home care via IV administration (both port and non-port...

  • Nursing Manager

    2 weeks ago


    Akron, United States Insight Global Full time

    Insight Global is looking for an experienced Nurse Manager to join a growing healthcare support agency sitting in the Akron, OH area. In this permanent position, the Nurse Manager will oversee a team of internal and external nurses, manage day-to-day operations, build the nursing team, and administer in-home care via IV administration (both port and non-port...

  • Nurse Manager

    1 day ago


    Akron, United States The Cleveland Clinic Full time

    Manages practice of professional nursing and delivery of nurse care on assigned unit. Establishes clinical direction for nursing care delivery, provides clinical supervision and maintains quality outcomes. Collaborates with liaison departments in mai Nurse Manager, Manager, Nurse, Patient Care, Nursing, Healthcare, Support

  • Registered Nurse

    2 hours ago


    Akron, United States Alternate Solutions Health Network Full time

    Agency:Summa Health at Home and HospiceOur culture and people are what set us apart from other post-acute care providers. We’re dedicated to the growth and development of our team to set them up for success. We CARE for our patients like they are our own FAMILY.HOW YOU'LL MAKE A DIFFERENCE:As a Registered Nurse Case Manager (RNCM) you will make a...

  • Nurse Manager

    4 days ago


    Akron, United States Cleveland Clinic Full time

    Join Cleveland Clinic Akron General where we have been providing world-class care to the community for over 100 years. At Akron General, you will work and learn from some of the best caregivers, provide and receive multitudes of support and appreciation, and create the steppingstones toward a rewarding career with one of the world's most respected healthcare...


  • Akron, United States Wyant Woods Healthcare Center Full time

    A DEEPER COMPASSION, FOR A HIGHER PURPOSE Nurses are at the heart of our world-class, patient-centered standard of care. Day in and day out, they go the extra mile to make a lasting difference in the lives of our residents and their families. Travel that extra mile with a team that will encourage you to make a difference. *Wyant Woods Healthcare Center* is...


  • Akron, United States Resiliency LLC Full time

    Job DescriptionJob DescriptionWhat is in for you:- A full-service, multi-disciplined engineering organization offering engineering/design, procurement, construction, construction management, EPCM, and EPC services to a broad range of markets.Maintains all relevant disciplines in-house to evaluate, design, and complete projects. Our skills and experience...


  • Akron, United States Summa Health at Home and Hospice Full time

    Agency:Summa Health at Home and HospiceOur culture and people are what set us apart from other post-acute care providers. We're dedicated to the growth and development of our team to set them up for success. We CARE for our patients like they are our own FAMILY.Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for...


  • Akron, United States Summa Health at Home and Hospice Full time

    Agency:Summa Health at Home and HospiceOur culture and people are what set us apart from other post-acute care providers. We're dedicated to the growth and development of our team to set them up for success. We CARE for our patients like they are our own FAMILY.Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for...


  • Akron, United States Cleveland Clinic Full time

    Join the Cleveland Clinic team, where you will work next to talented caregivers and provide exceptional and highly ranked care. Our guiding principle is putting the patient's needs first in every aspect of care and we are working harder every day to achieve that goal.As an Assistant Nurse Manager, you will provide administrative, clerical, and practical...


  • Akron, United States CHILDRENS HOSPITAL MEDICAL CENTER OF AKRON Full time

    Palliative Care Full Time Days 40 hrs/week M-F 8am-4:30pm Summary The Palliative Care Nurse Case Manager is responsible for managing a caseload of patients starting at initial consultation to Palliative Care and continuing through the lifespan or time of involvement with Palliative Care. Facilitates coordination of care by all members of the health care team...


  • Akron, United States ESPO Full time

    Job Title: Project Engineer Location: Akron, OH Job type and Duration: Contract to Hire Our client, a global Architecture and Design Firm, is looking to hire a Project Engineer to join their dynamic team in Akron OH. The Project Engineer's responsibilities include: Coordinate and lead project kick-offs and development of a project team to evaluate, refine,...


  • Akron, United States Travel Nurse Across America Full time

    Travel Nurse Across America is seeking a travel Interventional Radiology Technologist for a travel job in Akron, Ohio.Job Description & RequirementsSpecialty: Interventional Radiology TechnologistDiscipline: Allied Health ProfessionalStart Date: 06/17/2024Duration: 13 weeks40 hours per weekShift: 10 hours, daysEmployment Type: TravelPerks: *Day-One health,...